August 7, 2025EP EuropaceOpen Access

Prospective evaluation of carbon dioxide as a contrast medium in pacemakers or defibrillators carriers for venous angiography (SPARKLING pilot study)

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Why the study?

Evidence evaluating carbon dioxide as an alternative to iodinated contrast media for venous angiography in cardiac implantable electronic device procedures was limited to one small study.

Does carbon dioxide venous angiography provide comparable vessel visualization to iodinated contrast media in patients undergoing CIED procedures?

Comparison

CO2 vs ICM venous angiography

Design

Prospective, single-centre randomized crossover study

Authors

ASAlberto SpadottoElectrophysiology MCMaria CarelliAzienda USL di Bologna GMGiulia MassaroAzienda USL di Bologna

Discussion

Member takes

Implication

CO2 venography yields lower variability than ICM for subclavian assessment in CIED procedures; extends RCT evidence supporting its use as a contrast alternative.

Structured PICO

Does carbon dioxide venous angiography provide comparable vessel visualization to iodinated contrast media in patients undergoing CIED procedures?

Population

60 patients undergoing cardiac implantable electronic device (CIED) procedures, mean age 72.6 ± 13.1 years, 76.7% male. Key exclusions: right-to-left shunt, pulmonary hypertension, lung failure, or known allergy to iodinated contrast media.

Intervention

Carbon dioxide (CO2) venous angiography using an automated system delivering a 50 mL CO2 bolus at 300 mmHg, preceded by a 10 mL flush, with images enhanced using digital subtraction angiography (DSA) and stacking techniques.

Comparator

Iodinated contrast media (ICM) venous angiography (administered in a randomized crossover sequence).

Outcome

Vessel visualization evaluated by patency visibility and optimal visualization (defined as a lumen-to-background contrast enabling measurement of vessel diameter and degree of stenosis).surrogate

Carbon dioxide venography is a feasible and safe alternative to iodinated contrast media for venous visualization during CIED procedures, offering comparable imaging quality while potentially avoiding contrast-induced nephropathy.

Limitations

Single-centre design
Moderate sample size
Potential reviewer bias from image interpretation by two expert electrophysiology technicians

Cite This Study

Spadotto et al. (2025) studied this question.

synapsesocial.com/papers/6a6f65bc87f9210571271dcb https://doi.org/10.1093/europace/euaf172

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Implication

CO2 venography yields lower variability than ICM for subclavian assessment in CIED procedures; extends RCT evidence supporting its use as a contrast alternative.

Prospective evaluation of carbon dioxide as a contrast medium in pacemakers or defibrillators carriers for venous angiography (SPARKLING pilot study)

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Prospective evaluation of carbon dioxide as a contrast medium in pacemakers or defibrillators carriers for venous angiography (SPARKLING pilot study)

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider